2015 NCCL

Diversity Throughout AAFP Among Subjects Delegates Address

Lindsay Botsford, M.D., M.B.A., a new physician delegate from Sugar Land, Texas, explains a resolution she co-authored that asks the AAFP to support policies that require all employers to allow employees to earn sick leave.

During the 2015 National Conference of Constituency Leaders (NCCL), held here April 30-May 2, AAFP members from the five constituency groups -- women, minorities, new physicians, international medical graduates (IMGs), and gay, lesbian, bisexual and transgender (GLBT) physicians and those supportive of GLBT issues -- acted on resolutions considered by the Reference Committee on Organization and Finance.

Thus, it seems fitting that delegates adopted an amended resolution during the May 2 business session that focused on diversity.

The resolution called for the AAFP to review current practices for increasing the numbers of underrepresented populations at all levels of the organization and, after reviewing current best practice models to achieve workforce diversity, develop a report for the 2016 NCCL.

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Delegates to the 2015 National Conference of Constituency Leaders adopted, among other things, a resolution calling for the AAFP to review current practices regarding diversity in all levels of the association.

The delegates also gave a thumbs-up to a substitute resolution that asked the AAFP to support policies that require all employers to allow employees to earn sick leave they can take either when they themselves are sick or when they need to care for a sick family member.

Another resolution called for the AAFP to research procedures for forming a consortium for collective bargaining for family physicians and present a report to the 2016 Congress of Delegates.

Co-author Manisha Sharma, M.D., minority delegate of Baltimore, explained that the current AAFP policy on diversity in the workforce, updated in 2010, states that the Academy will "position itself in a leadership role in creating a medical workforce reflective of the patient populations family physicians serve."

"We must shift the mindset of diversity and inclusion from being a problem to deal with to diversity as a solution to the larger issues we face," she said. "Incorporating different backgrounds, values and experiences will allow for a more complete evaluation of the issues challenging the AAFP. Inclusion at decision-making tables can help use that diversity to improve health outcomes, policy, and cultural change and shift within the AAFP."

Another substitute resolution delegates adopted asked the AAFP to support policies that require all employers to allow employees to earn sick leave they can take either when they themselves are sick or when they need to care for a sick family member. It also noted that the AAFP should support policies that protect employees from retaliatory personnel action or discrimination because the employee took sick leave.

Lindsay Botsford, M.D., M.B.A., a new physician delegate from Sugar Land, Texas, co-authored the resolution and explained that family physicians should care about paid sick leave because 40 percent of the U.S. workforce doesn't have access to it. She also mentioned the Academy does not currently have a policy on paid sick leave.

Botsford explained that paid sick leave has a positive effect on patients' willingness to access preventive care, as well. "Imagine convincing a patient to get a colonoscopy if they have to take unpaid leave or risk losing their job to have it done," she said.

Kevin Wong, M.D., a minority delegate from Jeanette, Pa., presents his case for asking the Academy to consider helping members research procedures for forming a consortium for collective bargaining for family physicians.

This also helps decrease health care costs from patients using the ER on weekends or nights when they aren't working, Botsford said. "There have been states that have successfully instituted paid sick leave policy, and there is discussion over legislation at the national level currently on the issue," she added.

Lisa Lavadie-Gomez, M.D., a minority delegate from Iowa City, Iowa, supported the resolution and explained that she works with a patient population of about 3,500 people who are primarily Spanish-speaking. Many of them work on production lines at a nearby turkey processing plant. For every day of work they miss, they receive one point. If they accumulate too many points, they can be terminated.

"Oftentimes, they will forgo their diabetes follow-ups because they don't want a point against them," she said. "This resolution can help protect these employees and help them care for themselves and keep their jobs and support their families."

Resolution Calls for Family Medicine for America's Health Board Diversity

Delegates to the 2015 National Conference of Constituency Leaders (NCCL), adopted a resolution introduced during the May 2 business session that called for the AAFP to consider the diversity of its leadership on the Family Medicine for America's Health(fmahealth.org) Board. The measure also asked the AAFP leadership on the Family Medicine for America's Health Board to consider the diversity of the physician speakers featured during the Health is Primary(www.healthisprimary.org) campaign's city tour.

Glen Stream, M.D., M.B.I., Board chair for Family Medicine for America's Health, actually skipped a flight home from the NCCL to hear the conversation on this resolution. He pointed out that the AAFP's official representative to the Medicine for America's Health Board -- AAFP Board Chair Reid Blackwelder, M.D, of Kingsport, Tenn. -- and Jen Brull, M.D., of Plainsville, Kan., who represents independent practices on the Family Medicine for America's Health Board, also were there to hear the discussion.

"We have heard you loud and clear," Stream said. "I can simply tell you that improving the diversity both in our board and our tactic teams is an extraordinarily high priority for our board."

Stream explained that the constitution of the board represented the eight sponsoring family medicine organizations involved, and they each brought their own representatives to the team. In retrospect, this happened without enough coordination among them in regards to diversity.

Shortly after NCCL concluded, the group became more diverse when it selected Jewell Carr, M.D., of Huntersville, N.C., an African-American woman, to fill an opening on the tactic team for technology.

Delegates adopted another resolution addressing employment issues that called for the AAFP to research procedures for forming a consortium for collective bargaining for family physicians and present a report to the 2016 Congress of Delegates.

Resolution co-author Kevin Wong, M.D., a minority delegate from Jeanette, Pa., said, "Many independent physicians have been forced out of practice because they just cannot compete with the insurance companies and hospitals. We need something to help us organize and protect positions for those who want to stay in independent practice."

Co-author Cecil Bennett, M.D., a minority delegate from Atlanta, acknowledged the hesitancy that typically accompanies discussing anything resembling a union. "But the more I thought about it, the more I thought we have to at least have this discussion."

In private practice since 2001, Bennett said it continues to get more difficult for his business to survive. "I am one of two family physicians in my area who haven't been bought out by a hospital or gone out of business," he said. "I am an endangered species that is in the crosshairs of the hospitals. Like other private-practice physicians, you reach a point of having to see so many patients to survive but you aren't making enough money to hire someone to help you."

It's an issue he hopes the AAFP can work to resolve. "We feel that we need some support from the Academy to find a way for independent family physicians to be able to bond together when it comes to issues like reimbursement and other issues that affect us."

Ravi Grivois-Shah, M.D., a minority delegate from Tucson, Ariz., spoke in favor of unionized physicians but against the resolution, explaining he had spent the first 4 1/2 years of his career at the Cook County Health & Hospitals System in Illinois, where he was a member of the Service Employees International Union (SEIU). He said employed physicians currently have the power to unionize. However, physicians who work as independent contractors would face antitrust issues.

"I recommend physicians in different areas who are not employed physicians look at the laws where they live and look at ways that they can work together to improve their situation," Grivois-Shah said. "If they are employed physicians, I recommend they contact SEIU or one of the other existing unions and tell them they are interested in forming a union."

Among other measures considered by the reference committee, NCCL delegates also adopted recommendations that asked the Academy to

rename the "minority" constituency to a more inclusive and representative name such as "physicians from underrepresented races and ethnicities";

promote and support policies aimed at establishing paid parental/caregiver leave;

investigate collaborative relationships with financial institutions, including credit unions; and

review the idea of holding the AAFP Congress of Delegates and Family Medicine Experience only in states that explicitly prohibit discrimination based on gender, race and sexual orientation.